Integrative Psychiatry: Miracles vs. Madness Part II (radio)

11/14/12 – Dr. Hildy™ Welcomes Back Dr. David Gersten – Part 2 – Integrative Psychiatry: Miracles Vs. Madness « One Cell One LightRadio

Integrative Psychiatry:

Miracles Vs. Madness
(Part 2)

Integrative psychiatrist, Dr. David Gersten wrote:

Are You Getting Enlightened or Losing Your Mind?

A Psychiatrist’s Guide for Mastering Paranormal and Spiritual Experience

…to help bridge that gap.

Dr. Hildy™ welcomes back – Dr. David Gersten to share,
in Show No. 2, his intimate knowledge about:

~ Integrative Psychiatry: Miracles Vs. Madness ~

OneCellOneLight™Radio | Blog Talk Radio
Wednesday, November 14, 2012 –1:00-3:00PM Pacific
(2-4pm Mountain; 3-5pm Central, 4-6pm Eastern)

~~~~~~~~~~~~~~~~~~~~~
CLICK Here to Listen Live and for the archives after the show date:

http://www.blogtalkradio.com/onecellonelightradio/2012/11/14/11-14-12-dr-hildy-dr-david-gersten–miracles-vs-madness

Posted in EVENTS - RADIO/LECTURES/MEDIA, INTEGRATIVE PSYCHIATRY, PSYCHO-SPIRITUAL | Leave a comment

Radio Interview with Dr. Gersten on Integrative Psychiatry, Spirituality and Healing: with Dr. Hildy OneCellOneLightRadio.com

On October 3rd Dr Gersten was interviewed by Dr. Hildy. This was a vibrant interview. You can hear the interview at:

http://onecellonelightradio.wordpress.com/2012/10/01/10312-dr-hildy-dr-david-gersten/

Comedienne Lily Tomlin once asked, “Why is it that it’s called prayer when we talk to God, but when he answers back it’s called schizophrenia?”

Though framed as a joke, this outlines the prevailing attitude in Western culture when it comes to the spiritual and paranormal.  Almost half of all Americans claim to have had an unusual spiritual experience and as many more have had problems handling stress, anxiety and depression, but rarely are these two experiences considered to be related.

This week on One Cell One Light Radio, Dr. Hildy™ welcomes returning guest Dr. David Gersten to discuss his book, Are You Getting Enlightened Or Losing Your Mind?    Dr. Gersten strives to destigmatize spirituality, altered states of consciousness, visionary experiences, extrasensory perceptions, paranormal phenomena, and other important experiences so that patients can discuss them without being labeled crazy by their psychiatrists.

 

Posted in EVENTS - RADIO/LECTURES/MEDIA, HOLISTIC HEALING, INTEGRATIVE PSYCHIATRY, MENTAL-EMOTIONAL, PSYCHO-SPIRITUAL | Leave a comment

Radio Interview with Dr. Gersten on Amino Acid Therapy: Wed. 8/29/12 – Dr. Hildy OneCellOneLight Radio

Medicine has been lacking in the teaching of nutrition, mind-body techniques, spirituality, and sexuality.

Join Dr. Gersten in a radio interview with Dr. Hildy Wednesday 8/29 from 1-3 pm PST, dealing with the first of those 4 areas – nutrition and Amino Acid Therapy. 8/29/12.

Dr. Hildy and Dr. David Gersten – AMINO ACIDS – The Building Blocks of Life

OneCellOneLightRadio – Dr. Hildy

onecellonelightradio.wordpress.com

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3- LEVEL HEALTH MAP – A CAUSE-AND-EFFECT EXPLANATION OF CHRONIC ILLNESS

I began treating CFS/ME (chronic fatigue syndrome/myalgic encephalopathy) in around 1986. Having gotten a severe case in 1984 I had to make it my business to figure out how to improve and/or cure myself – which I did.

CFS/ME is incredibly complicated, but as I worked with many people with it, my success rate went higher and higher. I spent 2006 trying to figure out a cause-and-effect explanation of chronic illness.  All that medicine really had were “risk factors.”  For example, the American Heart Association has a list of 9 risk factors, but there really is no explanation at all. So, I thought about this constantly for a year, and finally came up with this 3-Level Health Map.

You can read the details at http://www.aminoacidpower.com/treat/healingTotalPerson

Let me explain the 3 Levels.

1.  Primary Causes

I was able to identify 38 categories of Primary Causes. Some common ones are infections, toxicity, protein deficiency, malabsorption, intestinal dysbiosis, genetics, and stress.  All chronic illnesses have a minimum of 7 primary causes.  In and of themselves, primary causes don’t harm you.

2.  How the Body Responds to Primary Causes

This is where the action starts.  The body responds to all primary causes with inflammation and the stress response (fight-or-flight).  Over the last decade medicine has come to realize that 80 chronic diseases are caused by inflammation.  If you look into the earthing technology (that’s another post), we have a natural way now to turn off inflammation.  Check out the radio interview I did on www.earthingUSA.com.

3.  Metabolic Chaos

Level 3 is about disturbances in total body biochemistry.  An illness like arthritis is Level I and II.  CFS/ME, IBS and most chronic illnesses have serious disturbances of biochemistry.  By dry weight our bodies are 60 -65% amino acids. So, Metabolic Chaos mainly involves problems with amino acid chemistry, but we have to take everything into account: carbohydrates, essential fatty acids, vitamins, minerals, and other co-factors for amino acid chemistry.

The 3-Level Health Map shows the cascade of events in chronic illness.  The black boxes represent dominos.  Let’s say you have a bad case of Epstein-Barr Virus. Behind that one “domino” 10,000 other dominos are lined up, and they collapse when the EBV domino falls. If you’ve got 7 primary causes, metaphorically you’ve got 70,000 dominos in disarray.

Level III is very deep. There are levels within this level. Everything eventually gangs up to cause problems with the Krebs cycle and the production of ATP, the molecule of energy.

Making Sense Out of Lab Work

When I review lab work with my patients, I write down all the primary causes, and at the end of the session, I tell him or her all of the primary causes.  In a nutshell, here’s the logic of treatment.

1) We want to identify and treat all the primary causes we can.

2) We want to turn off inflammation and normalize the stress response, and

3) We want to balance total body biochemistry.

I’m thinking in terms of cellular biochemistry.  There are about 70 trillion cells in the human body. Metabolic Chaos involves problems with those 70 trillion cells.

After the Health Map came together, I ran it past experts in 3 fields. There was one minor addition made to the Map as a result.  It makes it easy to explain to my patients why treatment in the past may have failed.  Treatment is hit-and-miss.  “Take a little of this, a bit of that.”  It’s kind of like throwing darts at the board from quite a distance and hoping you’re close to the mark.  All too often, treatment is really guesswork and people end up spending vast amounts of time, energy, and money on treatments that don’t work.

Now that you have an idea of the 3-Level Health Map, you can look at your own health challenges and treatments and try to figure out what is treating Level I, II,  and III.

Posted in AMINO ACID THERAPY, HOLISTIC HEALING, NUTRITIONAL-METABOLIC MEDICINE | Leave a comment

HEALING TRAUMA: THAWING THE FREEZE RESPONSE

Healing Trauma: Thawing the Freeze Response

reprinted from The Life Connection, September 2006

By David Gersten, M.D.

For decades, science has been mapping out the biology and psychology of the fight-or-flight response.  We react to every day stress the same way our ancestors, millions of years ago, responded to a confrontation with a cave bear.  The biology of fight-or-flight is the same whether we are facing a charging mountain lion or an angry boss.  Our heart rate increases, blood flows away from skin and the digestive tract and toward muscle (so that we can fight or run).

Peter Levine, Ph.D., author of “Waking the Tiger,” has spent decades researching trauma and has discovered a major, missing piece to the fight-or-flight response.  Dr. Levine holds a Ph.D. in medical and biological physics and a Ph.D. in psychology.  His first post-graduate training was in the field of biology, during which time he made some brilliant discoveries about the strategies animals in the wild use when under attack, and how those strategies apply to humans.

When under attack, the prey has the instinctual knowledge to fight, flee, or freeze.  The freeze response is the main subject of this article.  Let’s use an example of a cheetah stalking a herd of impala on a grassy plain in Africa.  The cheetah charges the herd, and, as a unit, the impala flee.  But the cheetah quickly discovers the weakest or slowest impala in the herd and begins to separate it from the herd.  The impala does not have the option of fighting the cheetah, so it runs for its life.  Given that the cheetah is the fastest land animal on the planet, the impala is going to lose this race.  The impala senses that the cheetah is closing in for the kill.  And then suddenly, the speeding impala stops and falls over as if it were dead, as if it has run into a brick wall.

Predators do not attack dead animals, so when the impala suddenly falls over, “dead in its tracks,” the cheetah is confused.  So, through the freeze response, the impala has one last chance at survival.  If the impala is lucky, the cheetah will treat the impala as if it were dead, and will grab hold of its leg or ankle and drag it back to its den.

Once home, the cheetah might scurry around looking for all of her cubs.  While the cheetah is taking care of the home front, the impala can start to come out of the freeze response.

Before we watch the impala run away and escape the jaws of death, let’s back up and examine the freeze response.  It is widely held that animals in the moment before death enter a state in which they do not experience pain.  It is as if they are having an out-of-body experience, and their spirit has left the soon-to-be-dead body.  The science behind this theory is complex, but you can understand why Nature/God would have evolved in a way to spare all living creatures from the final moment of suffering.  Through the freeze response the impala either survives or dies painlessly while in a numb, stunned state.

Back at the cheetah’s den, the impala is starting to regain awareness or consciousness as it comes out of the freeze response.  First it begins to tremble a little, and its eyes begin to focus again.  The trembling becomes quite extreme, with wild shaking.  And then it is over.  The “freeze” is over and the impala is back in fight-or-flight physiology.  It is now capable of running for its life…and winning this round of “predator-prey.”

When human beings are attacked or traumatized in some way, they will first go into fight-or-flight physiology.  However, sometimes, like with the impala, there is no escape, except into the oblivion of the freeze response.  Children, who are being abused or severely neglected, do not have the choice of fighting or escaping, and so they move into freeze mode.  They feel helpless, paralyzed, numb . . . even dead.  Because we have an advanced cerebral cortex, we interfere with Nature’s overall survival plan.  Our thinking mind gets us stuck in freeze mode, and, unless we spend most of our lives doing deep psycho-spiritual healing work, we will remain in freeze mode.

People who are stuck in freeze mode often feel helpless, numb, dissociated, walled off, and lifeless.  They often have difficulty feeling sensations of any kind within parts of their body, or even all of their body.  Many of you reading this right now, who are adult survivors of abuse/neglect, are resonating with what you’ve just read.  You know the numbness, the dissociation, the feeling that you have not fully lived your life.  And you know that these qualities of the freeze response have affected every intimate relationship in your life.  Some of you who are still recovering from a serious car accident will recognize qualities of the freeze response, for any trauma at any age can get “frozen in time.”

Getting stuck in freeze mode, during or after a traumatic event is not something that only happens to people who grew up in abusive homes.  All kinds of trauma often lead to a freeze response.  PTSD (post-traumatic stress disorder), which can be brought on by a trauma experienced as an adult, is a permanent state of freeze mode.  Every time you get into an argument that you can’t resolve, or feel you are in a traumatic situation in which assertive responding is risky, you enter freeze mode.  When your angry boss is yelling at you, initially you experience the fight-or-flight response, which then moves into freeze response.  You become more and more numb around that person, but the numbness, dissociation, and helpless feelings will spread to the rest of your life.  However, you may simply be feeling generally anxious or depressed and not connect those emotions with trauma.

Adult survivors of abuse are frequently re-experiencing trauma as adults, and handle most traumas through the freeze response.  For example, a husband may be arguing with his wife.  As she appears to “want answers,” her husband experiences the encounter as a trauma, and he becomes numb inside, and often speechless.  I have run into this situation countless times with patients, whether it is the male or female partner who is the adult survivor.  The more one partner pushes to get the information she wants out of her husband, the more she just wants him to talk, the more speechless he becomes.  He is not trying to be evasive.  He is frozen inside.  There are no words to flow from his lips.  He is the impala feeling the cheetah’s breath upon his neck, and he lost the ability to fight or escape a long time ago.  I invite all the couples reading this, who experience this kind of communication, to openly discuss what you’ve just read with each other to see if the communication problem is part of a freeze response, rather than one person simply being stubborn.

Dr. Peter Levine developed a therapy model, a strategy for dealing with trauma. He calls his work “Somatic Experiencing.”  I find it difficult to remember the term no matter how many times I read it, and so, I have chosen to refer to the work I do, inspired by Levine, as Body Centered Trauma Resolution (BCTR).  His approach is one that takes you into the body.  This is not about diving into intense emotions (emotional release work), working with your thoughts (cognitive behavioral therapy), or images.  However, during this work, strong emotion and mental images often arise.

I do not want to try to map out Dr. Levine’s work, providing superficial ideas and tools for the reader, for you will miss the depth of this work.  But, let me give you an idea.  One might start a session by allowing your awareness to scan through your body, simply noticing sensations.  Notice if an area is warm or cold, numb, tingling, painful, burning, energized, pressured, blocked, and so on.  Observe if any particular sensation is pleasant, unpleasant, or neutral.  Those who have suffered a lot of trauma will often find this exercise difficult at first, and may find that they can’t feel parts of their body at all.  They may need professional help to begin the process of re-connecting to bodily sensations.

By spending time simply observing sensations within your body, watching them arise, dissolve, slowly change, and shift around, you begin to re-connect.  Sensations are never static and unchanging.  Notice how they change.  Through this “awareness check” you begin to move out of the dissociation caused by trauma’s freeze response.  Dr. Levine began developing his approach, through the body, based on his observations of the animal kingdom and also by working with thousands of survivors of trauma.  He discovered that traumatized people feel numb and dissociated inside, and display the same physiological reactions as an animal about to be killed. For many people, trauma leaves them feeling like they have a head that is not connected to their body.

In this work, after observing bodily sensations for awhile (5 minutes or more usually), you identify a sensation that is particularly positive and another area that feels unpleasant.  And then you begin a process of “pendulation” (a term coined by Penelope Young-Andrade).  Here is the process.  You allow your awareness to move, shift, or swing from the pleasant sensation . . . to the unpleasant . . . back to the pleasant area . . . and again back to the unpleasant.  You allow your awareness to shift or swing from point to point, or area to area.  After awhile the area that felt unpleasant does not feel so unpleasant, and the area that felt the most pleasant has also changed.  The idea is that the difference between pleasure and pain begins to transform.  Frequently, you will reach the point, where both areas feel about the same.  Through “pendulation,” internal, sensory dualities begin to dissolve.  And then mental dualities begin to dissolve, soften, and thaw.

In a therapeutic situation, the process of sensory awareness just described often leads to strong memories, emotions, and images.  The task, with this work, is to stay out of your head, which is difficult for most of us.  We are working at an instinctual, animal level here, and the thinking mind does not serve a useful purpose.

Let me give you a simple example of an everyday trauma that almost all of us would mis-handle.  Dr. Levine was walking in an airport when he saw a man on crutches stumble down some stairs.  Immediately, people rushed to him, reaching out to help pull him back to his feet.  Dr. Levine rushed in, told everyone to back away, and that he had expertise in dealing with that kind of trauma.  He sat down next to the man, put his arm around his shoulder, and sat next to him silently.  The man was shaken, trembling, a bit spaced-out . . . traumatized.  Dr. Levine told him that it was normal to feel shaken up and that he should not try to rush through what he was feeling, and that he would just stay with him as long as was necessary.  After awhile the man felt back to normal and went on his way.

Now, what happened there in the airport?  When the man fell, he went into a state of trauma, including fight, flight, and freeze.  When people rush in to help out, lend a hand, and help someone get back up on their feet too quickly, they inadvertently make it more likely that the man will stay stuck in the freeze response.  We can actually add to the trauma unintentionally.  We need to be careful to help traumatized people experience what they are feeling and sensing, and not rush them.

Here’s another example.  Most of us have been in car accidents.  Part of the trauma is that we go into a freeze mode and get stuck there.  A few months ago, I was in a very minor fender bender in a parking lot.  I had parked, was opening my car door, and another car drove into the slot next to mine and slightly grazed my car door.  The other driver and I introduced ourselves and exchanged pertinent information (we acted like civilized people).  Twenty minutes later, I had driven to the beach and was about to get out of the car and go for a walk.  But I realized that I had entered a freeze state because of the car accident.  By going through the normal social graces at the scene of the accident, I ignored the slight trauma I had experienced.  I ignored what my mind and body were experiencing, until I noticed that I was feeling a bit numb and dissociated, which is the shocky state you feel after a car accident.  I spent about 7 minutes with my eyes closed.  First, I became aware of all the varieties of sensations in my body, and then I spent a few minutes “shifting my awareness” between positive and negative sensations.  And then I felt totally re-connected on all levels, and proceeded on my walk.

The implications of trauma and getting stuck in freeze mode are profound.  Ordinarily, our autonomic nervous system has a healthy balance between the sympathetic nervous system and the parasympathetic nervous system.  The sympathetic nervous system is involved in fight-flight-freeze physiology.  Adult survivors of trauma and abuse, who are stuck in freeze mode, are also stuck in “sympathetic nervous system overdrive.”  They tend to be guarded, slightly suspicious and prepared for the next insult or attack.  When you spend decades with your sympathetic nervous system revved up, the negative effect on your body adds up.  The parasympathetic nervous system (PNS) becomes suppressed when living in a chronic freeze mode, and the PNS is what is turned on when we need to heal.  Rest, yoga, massage, spending time in nature, and work with Body Centered Trauma Resolution re-balance your nervous system so that the PNS becomes more prominent . . . and sympathetic nervous system activity (fight-flight-freeze) diminishes.

Think of all the traumas, big and small, that you have experienced.  They put you into various degrees of freeze mode experiences (helpless, numb, detached, dissociated, speechless, paralyzed, and immobilized).  For those who grew up abused, every trauma in life just adds to the freeze mode.  Recently, I saw a woman, Julie, in my office who is in her sixties.  She grew up with a lot of abuse, neglect, and trauma.  The only time she ever felt “connected” was when she was in Nature.  Otherwise, she felt like something was missing in life . . . and she generally felt numb and helpless.  You would never know it if you met her.  I spent some time with her doing Body-Centered Trauma Resolution.

I saw Julie a month after our BCTR session, which had lasted about 20 minutes.  She was quite animated and told me, “I’ve done some great things.  Something has broken loose inside.  There have been a lot of people in my life for a long time, like 20 years, who really don’t support me.  They are not good for me.  I’m not good for them.  I called them up and I ended all of these relationships.  And next, guess what?  I’m seeing my mom soon and I’m going to tell her how I feel about the way she and her boyfriend behave around me, and how negatively they treat me.  And then, if they don’t stop their negative behavior, I will leave.”  Julie was exuding a new energy, but she had not put two and two together.  Her whole life was beginning to flow in a new way.  She was becoming unfrozen.

I explained to her that the brief BCTR work that we did moved her out of freeze mode.  She was no longer paralyzed, immobilized or numb.  She knew how she felt about a lot of things that she had simply been numb to for decades.  And she went into taking action, moving from “freeze” into fight-flight.  She was taking action based on felt emotion.  With her mother, she was now prepared to “fight,” or “tell it like it is” in an assertive way . . . and she is ready for “flight,” or to leave the scene if it remains traumatic in any way.  She was rather amazed at how she had transformed in 4 weeks, and she now had the understanding about why she was able to do what she did.

It is important to understand that trauma, physical or emotional, is registered in our bodies at a cellular level. So, spending years in therapy talking about your trauma will do very little good. Talking about trauma is necessary for a person who has never talked about it, and it’s necessary for military vets with PTSD. Military personnel are generally not wired to talk about their feelings, or their pain. In battle, they live and die for their brothers, and it is often seen as a sign of weakness to talk about one’s emotional turmoil. So, for returning war vets who experienced trauma, sharing their story in a group setting is an important first step.

In my practice, I take a very thorough initial history. It takes about 2 hours. I’m always interested in trauma, whether treating someone with a mental/emotional problem or a physical problem. I usually won’t spend more than 2 sessions finding out the details of the trauma. After I know about the trauma, and the existence of the freeze response in those with PTSD, we’ll move into BCTR work, along with specific interactive guided imagery techniques.

Trauma affects all of us, to one degree or another. One only has to go “inside,” become mindful of all the internal sensations, and go through a process of re-connecting.  And, I highly recommend that you read, “Waking the Tiger” by Peter Levine and/or picking up his audiocassette series.  He has provided the most powerful tools for transforming trauma that I have ever read, work that is helping to heal traumatized children, adult survivors of abuse, as well as the countless people in the world (especially in the Middle East and Africa), who suffer horrendous traumas every day.  It is difficult to comprehend the atrocities that human beings can inflict on one another.  The need for powerful tools to help all survivors of trauma is great.

 

 

 

Posted in INTEGRATIVE PSYCHIATRY, MENTAL-EMOTIONAL, PSYCHO-SPIRITUAL | 3 Comments

The Candida Epidemic – On the Rise

Candida Epidemic – On the Rise

By David Gersten, M.D.

 Tess was a sweet, intelligent, fifteen-year-old girl who suffered severely from a mysterious illness.  Her doctors at Kaiser Permanente told her she was crazy — that there was nothing wrong with her physically.  Traditional doctors rarely use comprehensive nutritional lab tests to diagnose a chronic illness.  For this reason, the Kaiser docs only found one abnormal lab result in eight months, which gave them no clues.  For eight long months Tess ran a fever of 102 to 104 degrees.  The final diagnosis?  “Pull yourself together young lady.  You’re just depressed.”

After Kaiser had given up on Tess as a “loony,” her mother, a long-term patient of mine, asked me to evaluate Tess.  Amino acid and immunological testing showed severe metabolic impairment, and an immune system similar to that seen in AIDS patients.  Tess definitely was not crazy.  But she was very sick.  After three weeks on specific nutritional supplements, her eight month nightmare was over.  She was finally in recovery. What was Tess’s mysterious illness?  Chronic Fatigue Syndrome (CFS) caused by a kind of yeast called candida albicans.

The Politics of Yeast

William Crook, M.D. wrote “The Yeast Connection” 15 years ago, and vast amounts of good research have been performed since then.  Unfortunately mainstream medicine still believes that candida can only be a problem if you are massively immuno-suppressed, either due to cancer, chemotherapy, or AIDS.  Feelings run hot in Medicine.

San Francisco physician, Dr. Robert Sinaiko was sued by the Medical Board of California for treating a boy with Attention Deficit Disorder (ADD) with Nystatin.  Judge Ruth Astle, who has no medical training beyond a five day seminar, presided over the case and decided that there was no basis for treating ADD with anti-candida medicines.

Dr. Sinaiko lost in court, was fined $95,000, given five years probation, and a host of restrictions as a doctor.  He was not sued for harming a patient, but for treating candidiasis.  He has since closed his practice.  One can only wonder. In September 1999, the Medical Board of California concluded that Dr. Sinaiko, M.D. had “departed from the prevailing standard of practice of medicine” by using antifungal drugs and other questionable methods to treat three adults and a nine-year-old child for nonexistent “Candida” problems. Sinaiko was assessed $49,472.79 for administrative costs and placed on five years’ probation with stringent supervisory conditions. However, in 2005 the Medical Board reversed all of its positions and Dr. Sinaiko was able to resume practicing medicine after being unable to practice for 6 years.

 Symptoms Abound

 If you or a loved one have any of the following symptoms or diseases, candida may be part of the problem:

Fatigue; CFS; Insomnia; Depression; Muscle weakness or pain; Abdominal pain; Hypoglycemia; Asthma; Intestinal gas or bloating; Heartburn or indigestion; Constipation or diarrhea; Sugar cravings; Frequent vaginal yeast infections; Headaches; Pain or swelling in your joints; Loss or decrease in Libido; Menstrual irregularities; Severe PMS; Sinusitis; Eczema; Psoriasis; Impaired memory or concentration; Panic attacks; Attention Deficit Disorder; Allergies.

With a list of symptoms this long, it should be no surprise that an estimated thirty percent of Americans have candida overgrowth (also called “candidiasis”).  That’s seventy-eight million people.  Now, very few of us will get as sick as Tess was, but we all need to be vigilant.

Let’s look at what candida is and how it can wreak havoc.  Within our gastrointestinal (GI) tracts we should have a healthy balance of candida (a kind of yeast) and “friendly” bacteria.  When you have just the right balance between the good bacteria  and candida in your gut, all is well, and the friendly bacteria are fed by the candida.  However, a number of things will throw off that balance, of which antibiotics are the chief offender.

When you take an antibiotic for your strep throat, sinus infection, bladder infection or anything else, that antibiotic kills unfriendly bacteria.  The problem is that the friendly bacteria in your GI tract that kept candida in check are also killed.  When that happens candida can get out of control, proliferating in your GI tract.  Birth control pills, some steroids (prednisone), and stress can all make things even worse.  If your immune system is not strong or your gut is not balanced, candida can ruin your health.

How It Hurts You

There are a number of complex mechanisms bywhich candida causes illness.  First of all, candida releases a number of toxic chemicals of which acetaldehyde and ethanol are the most common.

Second: Candida overgrowth causes intestinal inflammation and weakens the gut wall, producing a leaky gut.  If you have a “leaky gut,” large, undigested food particles can enter your blood stream.  When that happens, your immune system mounts an attack on the food . . . and you develop delayed food allergies. If, for example, you develop a food allergy to dairy, each time you eat dairy, your immune system will respond as if dairy is a foreign substance, and whatever symptoms you have will flare up. With delayed food allergies, which account for 95% of food allergies, your body does not begin to respond to the offending food for 6 to 72 hours after you’ve eaten.

Third: over time candida slips directly into the blood stream, causing systemic candida or “candidiasis.” Candidiasis can cause 50 ore more symptoms. Many experts believe that candida can colonize throughout your body.  The growth of candida cell colonies is a controversial subject among researchers.  Research will someday reveal why numerous trials of antibiotics increase the risk of developing candidiasis so dramatically

Candida overgrowth also causes short peptides (strings of 5 to 10 amino acids) to leak into your system.  Many of these peptides act as neurotransmitters.  These peptides send very unfriendly messages to your brain.  Not only that, they block neurotransmitter receptor sites throughout your body.

Every cell in our body is covered with tiny openings (receptor sites) where other chemicals come to nest.  Dr. Candace Pert, who discovered the opiate receptor, has shown that cells throughout our body have receptor sites for endorphins, the “feel good” chemicals our bodies make naturally.

When you are happy (or exhilarated through exercise), your brain releases endorphins throughout your body.  This causes receptor sites all over your body to also become “happy.”  But with candidiasis, toxic peptides can block your endorphin receptor sites, so your body literally loses its ability to feel good.  This is just one example.  There are hundreds of toxic peptides that can pollute your body when you have candidiasis.

 The Cure

If we suspect that a patient has candidiasis, we order a stool analysis test.  If candida is present, the lab will test to see which specific drugs and herbs among those available will actually kill it. I also order a blood test for candida antibodies. If the IgA result is elevated, that person has candida overgrowth in their digestive tract.  If the IgM result is elevated, that person has systemic candida.

Here are the four most important steps in treating systemic candida:

1.  Treat with a drug or herb that will kill candida.  Among medications, we frequently use Nystatin,  Diflucan, or Nizoral.  Some herbs include caprylic acid, uva-ursi, plant tannins, undecylenic, garlic, and olive leaf extract. Herbs can be effective in treating intestinal candida, but are not very effective for systemic candida.

2.  Replenish your GI tract with lots of friendly bacteria, namely acidophilus for the upper GI tract and bifidus for the lower GI tract. VSL is the strongest probiotic I know of, containing 250 billion friendly bacteria per capsule.

3.  Candida diet.  Anything that makes candida grow must be avoided including sugars, sweeteners, fruit, bread, aged cheese, and alcohol (beer is the worst). We provide patients with a complete printed list of which foods to avoid and which foods are good for them.

4.  Treat food and mold allergies.  Food allergies are determined by a blood test.

The results of proper treatment of candidiasis are profound. Tess fully recovered from her serious illness after we put her candida back in balance.  If you have any of the symptoms listed above, you should seek out a physician who understands candida, and do the simple testing.  Treatment will change your life.

  ADD/ADHD

I’ll write more in the future about ADD/ADHD. For now, a word about candida.  When I’m asked to evaluate a child with ADD/ADHD, the first question I ask is, “Has your child received a lot of antibiotics?” If so, chronic ear infections are the most common reason for repeated antibiotic treatment. ADD is not a “Ritalin deficiency.” The vast majority of kids I’ve treated for ADD/ADHD as well as the spectrum of illnesses (including Asperger’s Syndrome) have done very well. Sometimes the antibiotic-leaky guy-candidiasis equation is not the whole picture. For now, I hope this is food for thought.

Finally, some things for you to consider. The lab work is essential in making the diagnosis of candidiasis, but here are some other things to consider. Systemic candida can cause a coated tongue, toenail fungus that won’t go away, jock itch, and severe vaginal yeast. If you have areas of yeast that won’t go away, consider those symptoms as the tip of the iceberg.

It should be obvious that what we eat has a great deal to do with our health.  Likewise, if we have yeast overgrowth, the food we eat will not be fully absorbed, toxins will flood our bodies, and dozens of seemingly unrelated symptoms can arise.  Check out your gut.  A healthy gut is the doorway to a healthy body.

 

Posted in HOLISTIC HEALING, NUTRITIONAL-METABOLIC MEDICINE, THE POLITICS OF HEALTH | 8 Comments

Scientific Psychiatry, Part I

Scientific Psychiatry, Part I

David Gersten, M.D. Reprinted from The Life Connection Oct 2007

Several years ago there was an item in the media that caught my attention. Actor Tom Cruise had gone to visit actress Brooke Shields to formally apologize to her, after he openly criticized her for using Paxil, which she believes helped her recover from postpartum depression after the birth of her daughter in 2003. Cruise, a Scientologist, had previously insulted Shields and told her that such medication was never necessary.

Since 2004, Cruise has spoken openly about Scientology and its rejection of psychiatric drugs. On one occasion Cruise referred to psychiatry as a “Nazi science” in an interview in Entertainment Weekly.

Cruise’s beliefs come straight out of Scientology and the writings of L. Ron Hubbard, founder of Scientology, who believed that psychiatrists denied human spirituality. To some extent, Hubbard, in my opinion, is correct in his view that psychiatry (and psychology) has largely ignored man’s spiritual nature. Hubbard also proclaimed that psychiatry was “an evil enterprise, a form of terrorism, and the cause of crime.” According to Hubbard, “The psychiatrist kidnaps, tortures and murders without any police interference or action by western security forces.” Hubbard also claimed that the human mind was governed by biochemical reactions. I have to agree with him about that, but Hubbard saw that as a very bad thing, as if acknowledging the biochemical side of human beings was a denial of our spiritual side.

Tom Cruise’s attacks on the use of antidepressants, and all physical compounds, whose purpose is to foster better brain function, arise directly out of the rather warped mind of L. Ron Hubbard. While Cruise’s popularity in America has dramatically plunged over the past two years, I am concerned about fans of his who might take his opinions to heart, people who might greatly benefit from some medication.

History of Psych Meds

Let me step back in time to give you a brief history of psychiatric medication. Sigmund Freud, a neurologist, was one of the founders of modern psychiatry. He experimented with a number of compounds to assess their benefit for the mind. Not a great researcher in this area, cocaine was one of the favorite “medications” Freud was testing on himself.

On a more serious note, the discovery of Thorazine was a huge turning point for psychiatry and for millions of psychotic people. Like many discoveries, Thorazine was an accident. It was being developed as an antihistamine, but through a series of serendipitous events, scientists discovered that it helped schizophrenic patients. Within a few years, psychotic patients in long-term mental hospitals were being treated with Thorazine. The results were dramatic. Most schizophrenics, who had spent years locked in rather dismal facilities, suffering with voices and delusions, benefited tremendously from Thorazine. The benefits were so great that plans were made to begin emptying out the state mental hospitals. The overall plan was to build a county mental health system (CMH) throughout the country. Psychotic patients were discharged from the state hospitals with the idea that they could live on their own or in less structured, open facilities, and would go to CMH for medication and group therapy.

It was a wonderful idea that largely failed. It wasn’t that the medication stopped working. The failure was that huge numbers of schizophrenic people stopped going to CMH and stopped taking their medication. They lapsed back into a disorganized, confused schizophrenic state . . . and many of those people now form the foundation of the homeless people of America .

Another breakthrough in psychopharmacology, the first antidepressant, amitryptiline (Elavil), was also made by astute scientists, who were not looking for antidepressant medication. Amitryptiline had been invented and was being tested as a new antipsychotic medication. Numerous schizophrenic patients received amitryptiline. The study had good news and bad news. The bad news was that this new medication did not help schizophrenics with their psychosis. However, one researcher observed that some of these patients were less depressed. And the rest is history. Amitryptiline was tested as an antidepressant and it had significant benefit for people who were clinically depressed.

Generations of medications have come and gone since thorazine and amitryptiline. In the sixties, there was a backlash against psychiatry, and the anti-psychiatry movement was born. At the same time, psychiatry was struggling to find its identity. Was it more of an art or a science? That debate continues.

As a psychiatrist, I have often felt caught in a very strange place. I have treated thousands of people with serious mental illness, have worked with hundreds of people who attempted suicide, and have seen the light side and the dark side of psychiatry. I’m a pragmatist. First, I’m interested in what works. Secondly, I’m interested in why a particular approach works. During my psychiatric residency, which ended in 1978, I was taught that enormous research had proven that, in the treatment of depression, a combination of medication and psychotherapy was the most effective approach. Research continues to support that conclusion, but in many cases, I will use natural treatments, such as amino acid therapy, rather than a medication, and to the shock of nearly every new patient, I insist on psychotherapy as part of their treatment. The exact nature of my psychotherapy approach is not the point of this article, but I have not found that talk therapy is very useful after a couple of visits.

Psychiatry’s Identity

Driven by changes in insurance, the birth of managed care, rising overhead, and the desire to be perceived as “real doctors” by the rest of Medicine, many psychiatrists stopped honing their skills as counselors. Most people who see psychiatrists now expect a 15-minute medication evaluation. Huge numbers of psychiatrists are referring their patients to psychologists and the like for their “counseling needs.” For me, it is impossible to look at an individual as a “medication issue.”

My personal quandary is that I believe that, in general, psychiatry ignores spirituality and nutrition, over-diagnoses mental illness, over prescribes psychiatric medication, and has largely been ignoring psychotherapy. On the positive side, psychiatrists and psychiatric medications have alleviated enormous suffering.

Mental health is not different from holistic health. It is always best to treat the whole person. Medicine, in general, began to fragment patient care with the advent of specialties. Most of you know, that if you have a primary care physician, he or she will treat just so much, and will then make a referral to a specialist. As often as not, you get lost in a large bureaucracy in which the many doctors treating you may not all be communicating with each other. Even the specialists have sub-specialties, leading to further fragmentation in treating the whole person.

I have worked in every kind of psychiatric facility that exists, including: office outpatient, psychiatric hospital, medical patients in the hospital with psychiatric problems, board-and-care facilities, long-term lockup facilities in San Diego , long-term residential treatment facilities for children and adolescents, and long-term state psychiatric hospitals. When you have seen mental patients, by the tens of thousands, in so many facilities, you have seen a piece of society that very few people can comprehend. I’ve seen and treated every kind of mental suffering in huge numbers, worked with suicide and homicide, multiple personalities, alcoholism, and everything under the sun.

I would like to take Tom Cruise for a visit in a psychiatric hospital. I’d especially like just to sit with Tom in one of the long-term locked wards of the state mental hospitals. The patients there are the ones for whom nothing worked . . . not counseling, not medication, not all the work of social services. It is the end of the line. I’d like for Tom and me to sit down with a depressed schizophrenic patient and talk. I would ask Tom to use the methods he has learned from Scientology to “cure that patient.” The problem is that Tom would probably be so terrified to sit in a large room filled with people with chronic psychosis that this scenario would never take place, and if it did, Cruise would probably be requiring psychiatric medication in a short period of time to handle anxiety. It’s not that these people are dangerous. Mental patients are no more dangerous than the average person. It’s just that, if you have not spent years working with the mentally ill, it is a scary experience because you just don’t have a clue how to really connect, and how to be helpful. It’s understandable. That’s why psychiatrists have 8 years of training after college, and clinical psychologists spend 5 to 7 years getting their doctorate.

I’m a bit peeved that a celebrity, who has no training, who has not spent one hour in a psychiatric hospital, is making comments that are likely to cause at least a few people to stop taking a lifesaving medication. There’s a real possibility that there will be some suicides caused by Tom Cruise’s ignorant and biased remarks, the possibility that someone who really would benefit from treatment with an antidepressant medication won’t take it, because he believes Tom, and he’ll kill himself.

Psychiatry, like the rest of medicine, is an art and a science. Healing is the merging of the art and the science. In terms of psychiatry, there is not much science that generally goes into the consideration of what medication or other treatment you might need. Psychiatry is about brain, mood, thought, and behavior. That’s what we treat.

While there are countless factors that affect mental health that most psychiatrists don’t deal with (such as: mercury toxicity, Candida, parasites, food allergies, electromagnetic fields, spiritual disconnection, and lack of purpose), this article will focus on brain chemistry and neurotransmitters.

…Part II to follow soon.

Posted in INTEGRATIVE PSYCHIATRY, MENTAL-EMOTIONAL | 3 Comments

Gut Feelings —Digestive Healing

David Gersten, M.D.
reprinted from The Life Connection June 2008

Digestive disorders cause enormous suffering in America and throughout the world. Sixty to 70 million Americans (2% of the population) have been diagnosed with a digestive disorder. A recent study showed that in a single year there were 33.3 million visits to doctors in an outpatient, office setting and 15.7 million visits to emergency rooms for digestive disorders. Infectious diarrhea affects about one-third of us. There are close to 100 million new cases of infectious diarrhea each year. (this figure shocked me, so I checked it from numerous sources).

The most common symptoms we think of regarding gastrointestinal (GI) disorders are: gas, bloating, constipation, diarrhea, pain, heartburn, dyspepsia, nausea, vomiting, and acid reflux. If you don’t suffer from any of these, you’re lucky. If you do, you know how these symptoms can disable your life and cause terrible pain and suffering. Associated with these symptoms is a long list of medical diagnoses. The more serious GI illnesses kill, on average, 230,000 people per year.

Where to Start?
There are two main issues to think about:
1. Diagnosing digestive disorder symptoms and treating them. In addition, a formal diagnosis should be made.
2. Addressing the fact that GI disorders often cause problems with digestion and absorption of the food you eat. This is an issue rarely dealt with by conventional gastroenterologists. But it is a fact that, if you are having a hard time breaking down your food, you have a good chance of being protein deficient and/or having imbalances of essential fatty acids. After I do comprehensive nutritional testing, I frequently discover (based on Amino Acid Analysis) that the individual is deficient in protein. People often are surprised and tell me that they eat a lot of protein. The problem is that, although they are consuming enough protein, it is not getting into their bloodstream.

Let’s look at the anatomy of the GI tract. Food enters the mouth, proceeds down the esophagus to the stomach, where gastric acid and digestive enzymes pour in. The mixture of food and enzymes churns around for a couple of hours and then enters the small intestine, which is 25 to 30 feet long. The initial meal may take up to 48 hours to make its way to the colon, which is 3 to 5 feet long. The colon absorbs water back into the body from the totally digested food, and then finally you’re ready to have a formed bowel movement. The amazing thing to ponder is that you may eat a piece of protein like chicken, fish, or tofu . . . something approximately one square inch. By the time food is absorbed, it has been totally broken down into single molecules. From a piece of protein, eventually individual amino acids are absorbed in your small intestine.

If you’ve had a serious enough digestive problem to see a doctor, most likely he or she ordered a stool test. That test was a tiny smear of stool on a slide, for which the lab looks for any signs of blood, ova or parasites. Maybe, you’ve had an endoscopy, and swallowed a tube that allowed your doctor to have a direct look at your esophagus and stomach. If you are totally cured, you don’t really need to read any further.

Comprehensive Stool Analysis
In 1982 I introduced nutritional and metabolic testing into my practice and began routinely ordering Comprehensive Stool Analysis and Amino Acid Analysis. For the last few years, I have examined the state of a person’s GI tract through a test called the GI-2, performed by Diagnos-Techs Lab in Washington State . The GI-2 is part of my baseline testing, whether you have a digestive problem or any other chronic health challenge. The amount of information gained is tremendous compared to the standard “smear on a slide.”

Here are some of the 20 different things the GI-2 tests for:
1. Bacteria
Intestinal health is really the battle of the bacteria. We have about 2 pounds of bacteria in our GI tracts, and we want to have lots of acidophilus and bifidus (good bacteria). The GI-2 reports abnormal bacteria like Klebsiella and Citrobacter. These are not pathogens like the ones that send you to an emergency room, but they disturb the intestinal balance of bacteria. An imbalance is called “Dysbiosis.” It is important to supplement with high quality probiotics (friendly bacteria). I’ve checked out some of these in health stores and noticed that the number of bacteria per capsule is less than a billion. The products I recommend contain 15 to 20 billion friendly bacteria per capsule. This is one way the battle of the bacteria is won. We can also use various herbs to kill abnormal bacteria.
2. Yeast
There are many different kinds of yeast, all of which can be tested for. Candida is an epidemic and a major cause of digestive problems. In order to get a “real” picture of candida, I also order a blood test for Anti-Candida Antibodies. The blood test is the gold standard. It provides accurate information about whether a person has candida overgrowth in their GI tract, throughout their body, or in both places. This blood test reports the quantity of candida, a numerical value, which tells me if we should begin aggressive treatment of candida. If I repeat that test after three months of treatment, it tells me if the candida is gone, back in balance, or if we need to continue treating it.
3. H. Pylori
The bacteria responsible for ulcers
4. Intestinal Immunity
The GI tract is our first line of immune defense. Anything that compromises the health of our GI tract can impair our immune response. The GI tract should be lined with healthy antibodies that are prepared to fight infections. The “marker” for intestinal immunity is frequently abnormal, and so part of my recommendations will include ways of boosting intestinal immunity. If you have impaired intestinal immunity, it is more difficult for your GI tract to overcome parasites, bacteria, yeast, or viruses.
5. Digestive Enzymes
The pancreas produces enzymes to break down protein, fat, and carbohydrates. Those enzymes pour into the stomach when we eat. If we are deficient in digestive enzymes, we are going to have problems breaking down food, and that means we will not be absorbing the nutrients we think we are getting from our diet.
6. Inflammation

Any part of the GI tract can become inflamed. The most serious inflammatory bowel diseases are Crohn’s Disease and ulcerative colitis, both of which affect the colon, but can affect the last part of the small intestine. The GI-2 detects inflammation and helps the doctor figure out which part of the GI tract is inflamed.
7. Food Intolerances
The GI-2 tests for intolerance to dairy, soy, egg, and gliadin (a close relative of gluten). These problems are not the same as food allergies. A food that we are intolerant to irritates the lining of the GI tract. We can have a food intolerance for several reasons, including a deficiency in the digestive enzyme that breaks down that food. Lactose intolerance is the most widely known intolerance. Not all food intolerances are equal. In general, dairy and soy intolerance cause much worse intestinal irritation than do egg and gliadin. However,severe gliadin intolerance can indicate that more testing needs to be done to look for gluten intolerance. If the test shows food intolerance, it is best to remove that food from your diet for 4 to 6 months. I have treated people whose intestinal problems disappeared simply by removing a food they were intolerant to. For those who won’t give up cow dairy, I recommend that they switch to goat milk and cheese, which causes much less of a reaction.

By the way, our understanding of soy has gone through several incarnations. For a long time we viewed it as a terrific health food. Now we find that it is one of the main irritants to the GI tract. Furthermore, soy can act like estrogen.
8. Parasites
There are 2 main kinds of parasites: 1) single-celled parasites are called “amebas” and they only live in the GI tract and related organs, such as liver and gall bladder, 2) Helminthes, or worms, are larger, longer, multicelled critters that can live anywhere in our body. Diagnos-Tech’s GI-2 tests for Blastocystis Hominis, Giardia, Ascaris Lumbricoides (roundworm), Toxoplasma Gondii, Cryptosporidium, Trichinella, Entamoeba Histolytica, and tapeworm (Taenia). It is estimated that 80 to 95% of people living in North America has at least one parasite living inside their body. Most municipal water supplies in the U.S. contain protozoa like Giardia and Cryptosporidium and one in five Americans drinks water that violate federal health standards. Every year, nearly one million North Americans become sick from water-borne parasites and about one percent die. A study of 7 major rivers on the US Pacific Coast showed that all 7 rivers tested positive for the parasite cryptosporidium.
When it comes to parasites, I am pretty aggressive in treating them. By definition, parasites live off of our nutrients. Some of them like B vitamins. Some of them like calcium and live in (and on) our joints. In addition to depleting certain specific nutrients, they cause inflammation in the GI tract and throughout the body.

Additional Testing
The GI-2 provides more useful information than any other lab test I have worked with. Genova’s Comprehensive Digestive Stool Analysis is terrific, but the GI-2 is providing information that I find to be more helpful.
Amino Acid Analysis is one of the 3 most important nutritional/metabolic tests. One of its 40 sub-tests tells me if a person has leaky gut syndrome. There are other tests that can be done to further evaluate the GI tract. But, with the GI-2 I have a wealth of data that usually helps solve digestive problems that had previously been called “untreatable.”
I could add more and more information to deepen your understanding, but I won’t. Let me share one “factoid.” Stress is a big trigger of digestive problems, especially irritable bowel syndrome.

Stress causes our adrenal glands to get out of balance in their production of cortisol and adrenalin, and these hormonal imbalances will affect the GI tract, especially affecting the motility (rhythmic, peristaltic movement of the GI tract) and the immunity of the GI tract.

The Mind-Gut Connection

The GI tract is hard-wired to our brain and spinal cord. We have an enormous number of nerves that go from our spinal cord to different parts of the GI tract. This is why people literally “feel something in their gut.” If you have just experienced a personal tragedy, you may double over with abdominal pain. Your “guts” are feeling the emotional pain. More than any other body part, our GI tract is closely “hard-wired” with our central nervous system, making that part of the mind-body connection an inseparable unity. That’s why it’s important to learn to trust our gut feelings.

In order to heal a digestive problem, information is our most powerful tool. The GI-2 gives us the facts (data) that we need to work together and come to logical, reasonable treatment strategies.

While steroids are lifesaving for an attack of ulcerative colitis, and proton-pump inhibitors, like Prilosec, relieve heartburn and acid reflux, the information we gain from truly comprehensive digestive analysis helps us move from “temporarily keeping symptoms at bay with medication””— to treating underlying causes and finding a lasting cure.

A “lifetime sentence” of gas, bloating, abdominal pain, constipation, diarrhea, heartburn, or acid reflux is usually really “temporary””— once we have the right data to look at.
Is it not interesting that a psychiatrist eventually came to the conclusion that it is essential to repair brain chemistry and the digestive tract as top priorities. If we don’t heal the gut, you won’t be absorbing anywhere near 100% of the food and nutrients you ingest.

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A 911 Miracle: the Great Soul Migration

Three years after the 911 tragedy, I became friends with a shaman, White Buffalo Medicine Heart, the great great granddaughter of Nicholas Black Elk, who was the most revered Native American shaman in recent history. In a vision, she saw the second attack on the Twin Towers, the South Tower, as it occurred. She was not watching television or listening to the radio. She saw the impact of a plane exploding into the South Tower, and she saw thousands of colorless souls, in black-and-white, ascending. Somewhere above the Towers she saw a horizontal rainbow, a beam of multi-colored light with unearthly, beautiful colors. As each soul passed upward through the rainbow, it instantly became filled with the rainbow light, and was saturated with this Divine Light. Soon the entire sky was flooded with thousands of lit up souls. As the souls rose higher, they moved closer together, rising higher and higher, almost as one giant mass of light. Thousands of departed, multi-colored souls, traveling upward burst into light, heading toward the one Great Light. No soul was left behind in this great migration.
It is a great blessing to have among us people with second sight who can tell us what we cannot see with our five senses. It is comforting to know that out of the ghastly flame, smoke, and ash, thousands of human beings experienced the highest transition, and the quickest transformation of their souls imaginable.

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HOW SANE IS THE INSANITY DEFENSE?

With Jared Loughner in the news regarding the shooting of Rep. Gabrielle Giffords and the deaths of a federal judge, a congressional aide and four other people, the use of the insanity plea again is in the spotlight. When using the insanity defense, the defendant claims that he was not responsible for his actions due to mental illness.

I don’t see an answer that will satisfy everyone and every angle of the problem, but for starters here are my suggestions.

1. Hold a trial to determine if the defendant committed the alleged crime.
2. If the verdict is “guilty,” then the court’s next step is to determine the punishment. Let’s use 20 years in jail as an example.
3. Only after the trial of guilt or innocence will the issue of insanity come up. This can be done through a separate trial. The 2nd phase would deal with a determination of insanity.
4. If the convicted criminal is found to be insane, his 20-year sentence would begin in a psychiatric hospital for the criminally insane. If after 5 years of treatment, the mental illness is improved to the degree that the individual could be discharged from the psychiatric hospital, he would then be transferred to prison to serve out the remaining 15 years.

By way of background, I’m a psychiatrist who’s been in practice for 33 years. I’ve worked extensively with the severely mentally ill. I learned something very important just a month or two into my psychiatric training. I was notified of a very violent 30-year-old Samoan male (I’ll call him Sammy) who would be under my care. The nurse on my team showed me Sammy. He was in a padded seclusion room, making non-human, guttural aggressive sounds, and smashing his elbows into the walls of the room, causing some minor damage to the seclusion room.

The nurse and I looked through a 4 X 4 inch window into the seclusion. It was frightening watching Sammy. The nurse, who had been holding a small paper cup with liquid haldol (a powerful anti-psychotic medication), cracked the door open, slipped the haldol into my hand, pushed me into the seclusion room and shut the door behind me. As I walked into the room, Sammy uttered his first words, which were, “I…am…going…to…kill…you!” I cannot describe the intensity of his words. I said to him, “Sammy, you have a choice. You can drink the liquid or we can give you a shot.” He replied, “Oh, I have a choice?” to which I said, “Yes, you have a choice.” Sammy quickly chose to drink the liquid haldol.

When I walked out of the seclusion room, I felt my legs turn to rubber. I’ve never had that experience before or since then. Years later, I wondered how I knew the right thing to say. I learned so much from that one experience so early in my training. If I act “as if” someone has free will, they are much more likely to behave as if they do have free will. If I act in a way that conveys the message, “You’re insane and dangerous and have no choice over your actions,” my patient will behave as if he has no free will at all.

Let me backup briefly. Why did I bother to mention that Sammy was Samoan? The culture-bound disorder called “amok” (as in “running amok”) originated in Samoa. It is a condition in which a man becomes violently out of control, killing whoever is in his way. Amok is concluded when the afflicted person running amok is killed. Sammy suffered from clear-cut paranoid schizophrenia. The cultural dimension of running amok added to the total picture of great danger.

I’m grateful for that early experience because throughout my career I have taken the position that people will behave more rationally if I act “as if” they have a choice in their actions. Psychosis, whether schizophrenia or mania, is not a license for violence.

My early experience with Sammy set the stage for my earliest beliefs about the insanity defense. If we give society at a large the message that, “If you are psychotic, you are less responsible for your actions,” we’re conveying the wrong message.

So, first try the individual to determine if he committed the crime. The insanity plea would not be allowed in the first phase of the trial. Once convicted, then proceed with a trial to determine sanity, and proceed with psychiatric treatment if the individual is found to be legally insane.

Here’s the conflict. It is true that when someone is in the midst of a psychotic episode, they are not thinking clearly and their judgment can be poor. They may be in a storm of confusion. And there’s the dilemma. If we behave in a way that tells others that they are responsible for their actions, their behavior is much better. There are obviously kinks to be worked out, but for starters, I believe that the starting point for a less insane use of the insanity defense is in first trying an individual to determine if he or she committed the crime they are accused of.

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